A systolic blood pressure 140 mm Hg or above or a diastolic pressure of 90 mm Hg or higher would diagnose hypertension. A blood pressure above 115/75 is associated with increased risk of “stroke, myocardial infarction, heart failure, renal failure and cognitive impairment.” The best determiner of risk of death is a systolic blood pressure over 115 mm Hg.

From 1990 to 2002 blood pressures increased in the United States, while consumption of fruits and vegetables decreased and abdominal obesity increased, both associated with hypertension. Hypertension increases with age for the general population. But, people whose diets include mostly vegetable products and who have low salt intakes have little increase in hypertension with aging.

Essential hypertension is diagnosed when a specific cause of hypertension cannot be found. Treatment of essential hypertension includes “a healthful dietary pattern, reduced sodium intake, and a reduced body fat.” Essential hypertension often seems to be due to altered genetics impairing the person’s ability to remove sodium by the kidney. Increased sympathetic nervous activity, aging and obesity play a part. Reduced sodium allows the muscles of the blood vessels to relax so the vessels can dilate.

Diets to lower blood pressures “emphasize fruits, vegetables, and low-fat dairy products; include whole grains, poultry, fish, and nuts; make use of unsaturated vegetable oils; and contain smaller amounts of red meat, sweets, and sugar-containing beverages.” DASH (Dietary Approaches to Stop Hypertension) diet has been studied carefully. This study demonstrated that the diet which reduces hypertension the best was “rich in fruits and vegetables, and low-fat dairy products and relatively low in saturated and total fat.” DASH diet studies suggest that hypertension due to aging may be preventable by following the DASH diet.

Patients who have blood pressures over 120/80 should make the same dietary changes as made for hypertension. Sodium restriction is very effective. The authors “encourage patients to eat poultry, fish, nuts, and legumes instead of red meat; low-fat and nonfat dairy products instead of full-fat dairy products; vegetables and fruit instead of snacks and desserts high in sugars; breads and pastas made from whole grain instead of white flour; fruit itself rather than fruit juice; and polyunsaturated and monounsaturated cooking oils…”

Women, Afro-Americans and people with metabolic syndrome get the best response to sodium restriction, with greater reduction in blood pressures.

CONCLUSION: The DASH diet is suggested to prevent and treat hypertension. The author’s advise that no more than 1.5 gm of sodium is optimal.

PMID: 20519681.

Summary #388.